Alaska CARES

With sexual assault and child abuse cases hitting all-time highs for Alaska CARES Child Advocacy Center and Forensic Nursing Services of Providence in Anchorage, construction is rapidly moving forward on a new multi­disciplinary facility in Midtown.

A safe place for Alaska’s most vulnerable victims

The custom-designed center—which will continue to house detectives from the Anchorage Police Department Crimes Against Children Unit and Special Victims Unit; an investigative unit from the Alaska State Troopers; Office of Children Services; Alaska CARES; and Forensic Nursing—broke ground in February, and it’s anticipated service providers will be settled into their new offices by April 2019.

Treating Trauma

“We are on track to see Alaska CARES work with about 1,000 children this year. And Forensic Nursing is also seeing record numbers,” says Bryant Skinner, manager of Alaska CARES and Forensic Nursing Services of Providence.

Though the year was nearly over with about 250 cases in Forensic Nursing in October, Skinner expects to see that number jump closer to 350 by the end of December, which would be a 40 percent increase over prior years.

“Unfortunately, the holidays are often the busiest time of year in Forensic Nursing,” Skinner says.

Alaska CARES Medical Director Dr. Cathy Baldwin-Johnson notes that for many years Alaska has had one of the highest rates per capita of child abuse and sexual assault in the country.

“There’s probably a number of different reasons for that,” Baldwin-Johnson says. “There are a lot of people who move to Alaska who are isolated and don’t have a lot of other family or social support. We have a lot of problems with substance abuse in our state, which certainly contributes to the problem. We also have generational and historical trauma in our state, so I think it’s multi-factorial.”

The increased risk factors of maltreatment of children also include mental health issues, depression, and seasonal affective disorder.

Current Issue

February 2019

Lieutenant Shaun Henry, commander of APD Detective Team 3, which includes the Crimes Against Children and Special Victims Units, says that another reason for the higher number of reports in Anchorage could be the continued expansion of facilities and resources for victims to seek aid for sexual assault, abuse, counseling, or medical necessity.

“It’s my belief that, by providing these necessary resources and making them more available to the Alaska community, more people will be able to report the incidents and get the assistance they need,” Henry says. “The new facility is a very desirable and most welcome upgrade for everyone working together as a team inside it. As we continue to grow, so that we may provide better services to the public, more space is definitely needed and this new facility gives us one—of many—opportunities to do just that.”

Rendering of the northwest corner of the Alaska Cares Child Advocacy Center, currently under construction.

KPB Architects | Providence

Alaska CARES

A big part of that picture is Alaska CARES, which is responsible for helping children who have experienced trauma from abuse. The Child Advocacy Center was established to provide comprehensive, child-centered, and compassionate care.

“Victim advocates, law enforcement, child protection, tribal health, forensic medicine, and mental health professionals all work together in the same facility to support Alaska’s most vulnerable children,” the Alaska CARES website says.

The Child Advocacy Center model is the brainchild of former Alabama congressman Robert E. Cramer, who was a district attorney in Madison County, Alabama, in the 1980s when he saw a need to create a better system to help abused children.

What he noticed was that children were being asked to talk about a traumatic experience over and over as they moved between different departments and agencies, from medical providers to police departments.

Skinner explains the model was created as a way to bring all those professionals into one place and have them work as a team, reducing the trauma for the child.

“The foundation of the model really is the multidisciplinary team that we work with, all of them really buying into this idea of putting children first in our investigations, our decision making, and how we are approaching a case,” Skinner says.

“That means coming together as a team and deciding who’s best to do the interview and making sure we are trauma-focused in our response. It’s very helpful for us—and we are very blessed—to have all our partners that we primarily work with under one roof.”

The program was co-located in its current facility in 2007 and witnessed an almost 20 percent jump in cases that year.

“I think it allowed us to better collaborate and communicate about what’s best for kids and allowed medical professionals and advocates to advocate for what’s best for them and kind of have the ear of those state agencies and better serve more kids,” Skinner says, noting that it seems unreasonable to assume that the increase was a coincidence.

With the leases expiring for the current building, which is owned by Alaska Native Tribal Health Consortium, it was necessary to find, or build, a new facility.

The Upgraded Facility

Construction of the new, almost $13 million facility is funded by Providence Health & Services Alaska and many community partners that have contributed roughly half of the costs to date.

“We’ve gotten some really major gifts from amazing partners, including Southcentral Foundation, Rasmuson Foundation, ConocoPhillips, and others that have really stepped up to support the project,” Skinner says. “It’s really a combination of Providence taking a lead and then also asking the community and our other partners to help out.

“Providence sees these services as really mission driven. They’re not services that create a lot of revenue. When you’re serving sexual assault victims, whether children or adults, those aren’t services that are billed in a way that you can have a lot of cost recovery and justify a new space like this.”

A polar bear exam table is part of the new, custom-built Alaska CARES multidisciplinary facility set to be operational next year.

Providence Health & Services Alaska

With Providence supplying the necessary up-front funds, a team was pulled together to design the new space; the team visited facilities in the Lower 48 to gather ideas and determine which of those could be best implemented in Alaska.

One of the primary adjustments to the overall design for the Alaska CARES facility is how patients flow through the building. Children no longer need to walk through staff space; instead they will only be in contact with the team that is working directly with them.

“You might have a child who has “You might have a child who has come here and talked about some sort of abuse and then comes back for therapy and has to walk through the same space where they did a forensic interview or a medical evaluation,” Skinner says. “We pulled that portion of our program out and we have a very different space designed for that. So they are not walking through that same space again, as often it might re-traumatize them or bring up those memories.”

Major changes were also made to the forensic interview rooms, which are now completely soundproofed.

“We put a lot of effort into making sure there is no transference of sound from the rest of the clinic or even the other interview rooms when we’re doing multiple interviews. A lot of thought went into that to make sure that children are not distracted during a forensic interview by other staff walking by or noises from the next room or the rest of the clinic,” Skinner says.

The medical exam rooms were also redesigned, explains Baldwin-Johnson. The new rooms will be larger to provide staff the necessary room for forensic evidence collection. Additionally, the rooms were created to be as child friendly as possible.

“For example, one of the exam tables we use for younger kids actually is shaped like a polar bear,” Baldwin-Johnson says. “The colors in the room are going to match with the bear’s colors; the polar bear has blue eyes, so we’re kind of bringing in some of those calming blue colors in that exam room and then the paint and everything is going to reflect that.”

Building equipment sits in front of the Alaska Cares construction site in late October 2018.

The exam tables were also created to help empower children and make them more comfortable.

“The exam tables are fully accessible, which means that they go down really low so that even a relatively small child who is mobile can climb up onto the exam table themselves and be empowered by that,” Baldwin-Johnson says.

The design changes significantly in the exam room for older kids and teenagers who might be victims of sexual abuse or sexual assault. The color scheme in this room uses purples and greens, which are healing colors, explains Baldwin-Johnson.

“We put a lot of thought into this for forensic nursing as well,” Skinner says. “Adult victims of sexual assault have a separate entrance that is really mindful of their privacy.”

Adult patients are brought into exam suites, which have an interview room, a small waiting area, and a bathroom with a shower.

“If we didn’t do that work, those victims would likely go to an emergency department and be sitting—you know how it is at an ER—sitting with many different people. And then they would have their exams in an ER room where it’s noisy, there’s multiple people, there is very little privacy, so a lot of thought went into that design,” Skinner says.

“A lot of adult victims of sexual assault were also child abuse victims,” Baldwin-Johnson says. “They have trauma in their past, and so Alaska CARES is really working to have early intervention with young people and put them on a better path in hopes that we don’t have to serve them in forensic nursing later on.”

In all cases, Henry points out that having other agencies “just across the hall” will continue to be very beneficial with regard to efficiency and providing the best care to those served.

“Anytime you have a team environment, as we do with everyone working out of the MDC, it just makes sense to have them close by and ready to help each other out,” Henry says. “The victims and community members that the various agencies in the building serve deserve the best response from us, and this new facility will allow us to do just that.”

Though funding for the new facility wasn’t confirmed until February, Davis Constructors & Engineers started work on the site the day after the money came through, putting the project on target for completion in February 2019. Everything is still on track, and Skinner, Baldwin-Johnson, Henry, and their colleagues are set to hit the ground running in April, continuing to provide essential services to some of the most vulnerable members of our community.

Nominated by the Alaska Chapter of the National Association of Women in Construction, 2018 Engineer of the Year Christine Ness is a fire protection engineer and project manager at PDC Engineers, an Alaska-based firm with five offices and more than one hundred employees. Ness always knew she wanted to be an engineer and, after moving here in 2013, found in Alaska the happy combination of her many loves: a brilliant husband, ample opportunities for solitary fishing excursions, and the ability to pursue her passion to make the world a little more fire resistant.